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Heartburn Drugs Linked to Serious Kidney Disease

New data corroborate risk of PPIs

People taking proton pump inhibitors (PPIs) for heartburn are at increased risk of severe kidney disease, according to a Reuters report. A new study of hundreds of thousands of patients in Department of Veterans Affairs (VA) databases has found that new users of PPIs without kidney disease were 30% more likely to develop chronic kidney disease (CKD) over the course of five years. Moreover, their risk of kidney failure was doubled.

PPIs such as esomeprazole (Nexium, AstraZeneca) and lansoprazole (Prevacid, Takeda) are prescribed to treat ulcers, heartburn, and acid reflux and are some of the most effective forms of treatment available, the authors write in the Journal of the American Society of Nephrology. However, although these drugs are generally viewed as safe, they may be overprescribed and may be continued for longer periods than necessary.

The researchers analyzed data in national VA databases on 20,270 people who had recently started taking PPIs. They compared this group with 173,321 people who had started taking histamine (H2) blockers to reduce stomach acid. All of the patients were free of kidney disease at the start of the study. They were followed for five years to see whether their kidney function changed.

The PPI group, compared with the histamine-blocker group, had an increased risk of an estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.73 m2 and of incident CKD (hazard ratios [HRs], 1.22 and 1.28, respectively). Patients treated with PPIs also had a significantly increased risk of doubling their serum creatinine levels (HR, 1.53); of an eGFR decline exceeding 30% (HR, 1.32); and of end-stage renal disease (HR, 1.96). In addition, the authors detected a graded association between the duration of PPI exposure and the risk of renal outcomes among those exposed to PPIs for 31 to 90 days, 91 to 180 days, 181 to 360 days, and 361 to 720 days compared with those exposed for less than or equal to 30 days.

“Patients should appreciate that, like all drugs, PPIs carry risk. The fact that they’re available over the counter doesn’t mean they’re safe,” Dr. David Juurlink, a drug safety researcher at the University of Toronto, told Reuters. “People who take PPIs and are later found to have kidney problems should ask their physicians whether the drugs might be playing a role.”